Please Register your child - Friendship Circle

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FriendsColumbus.com » Parents » Register Your Child

What Can FC offer you and your child?

Caroline Shares her FC Experience

One parent shares the joy FC has brought to her family

Home Visitation

Friendship Circle Programs

Please Register your child

Parent's Survey

All participants need to register each year so we can
keep our records up-to-date.

Please complete the following form and click "submit" below.

Child's Last Name:  

Child's First Name:

Date of Birth:
 

Address:   

City:  

Zip:  

Home Phone:   Email:

Child's Diagnosis:
  

Mode of Communication (Verbal, signing, written, computer, or other):
 

What kind of activities does he/she enjoy?

What kind of activities does he/she not enjoy? 

 
What type of activities would you like our volunteers to focus on? 

Most effective motivator:  

Most effective positive reinforcement (praise)?

Event/circumstances that trigger behavior issues?   

Does your child have seizures?   Yes No

If yes, what type and frequency:  
 

Allergies?  Yes No 

If yes, please list:  

 
Any/All information regarding social/behavior skills, that we should be aware of?

Do we have permission to share this information with the volunteer?   
Yes No 

Does Friendship Circle have permission to publicize pictures of your child to promote the program?  
Yes No 

Are you interested in home visits? Yes No 

If yes, what are the best days/times for visits?

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Mother's Info

Name:

Address:    City:     Zip:

Home Phone:    Cell Phone:

Work Phone (include extension):

Email:

Father's Info

Name:

Address:    City:     Zip:

Home Phone:    Cell Phone:

Work Phone (include extension):

Email: